YR2 BB OVERVIEW Flashcards
1
Q
Ganglion vs nucleus
A
Ganglion - PNS - one exception is the basal ganglia
Nucleus - CNS
2
Q
Function of the basal ganglia
A
Regulate the intensity of movements
Inhibit antagonistic/unnecessary movements
Regulate attention and cognition
Motor program switch - from resting state
3
Q
(Dorsal) striatum
A
Caudate + putamen
4
Q
Corpus striatum
A
Striatum (c+p) + globus pallidus
5
Q
Lentiform nucleus
A
Putamen + globus pallidus
6
Q
Location of substantia nigra
A
At the base of the midbrain
7
Q
Ventral striatum
A
Nucleus accumbens
8
Q
Neurotransmitter input from cortex to dorsal striatum
A
Glutaminergic
9
Q
Neurotransmitter input from substantia nigra to dorsal striatum
A
Dopaminergic
10
Q
GABA excitatory or inhibitory?
A
Main inhibitory neurotransmitter of the CNS
11
Q
D1 receptors excitatory or inhibitory?
A
Excitatory
12
Q
D2 receptors excitatory or inhibitory?
A
Inhibitory
13
Q
Summarise the direct pathway of the basal ganglia
A
a
14
Q
What is the general action of the GPi on the motor thalamus?
A
Tonic inhibition of the motor thalamus to prevent sudden movement
15
Q
Which direct or indirect pathway is tonically active?
A
Direct pathway
16
Q
What is the function of the direct pathway
A
Allow for movement (?)
17
Q
What is the internal capsule?
A
White matter structure separating the caudate from the putamen and the globus pallidus
18
Q
Primary motor cortex is broadmann area…?
A
4
19
Q
Location of primary motor cortex
A
Just anterior to the central sulcus
20
Q
Distribution of the motor homonculous
A
Feet and legs centrally
Hip, trunk and shoulder
Hands and Fingers
Face
21
Q
Arteries to the basal ganglia
A
Lenticulostriate arteries
22
Q
Consequence of damage to premotor cortex or supplementary motor cortex
A
Apraxia
23
Q
Effect on reflexes and muscle strength from apraxia
A
Normal reflexes and muscle strength
24
Q
Apraxia
A
Inability to perform complex motor movement
25
Aphasia
Inability to understand or produce speech
26
Motor aphasia
Difficulty putting words together in a sentence - will use very simple or short sentences ( no problem understanding)
27
Consequence of damage to Broca's area
Motor aphasia
28
Consequence of damage to FEFs
Oculomotor aphasia - difficulty moving the eyes horizontally and in following objects
29
Location of the somatosensory cortex
Parietal lobe
30
Location of prefrontal cortex
Right at the front of the frontal lobe (area 9)
31
Function of prefrontal cortex
Involved in the planning of movements and in executive functions
32
Consequence of damage to prefrontal cortex
Personality changes
| Lack of ability to plan tasks
33
Location of orbitofrontal cortex
Most anterioinferior region of the frontal lobe (area 11)
34
Consequence of damage to the orbitofrontal cortex
Pseudopsychppathoc behaviour - impulsive, sexual disinhibition, lack of concern for others
35
Consequence of damage to the motor thalamus
Severe paralysis
36
Input into the corticobulbarpinal tract
a
37
Output from the corticobulbarspinal tract
a
38
Termination of the corticobulbar tract
a
39
Location of decussation of the corticospinal tract
aa
40
Function of corticobulbar tract
a
41
Pyramidal vs. extrapyramidal tracts
a
42
Which horns of the grey matter do pyramidal and extrapyramidal tracts run through?
a
43
Consequence of damage to the reticulospinal tract
a
44
Define spasticity
a
45
Define clonus
a
46
Define hyperrelexia
a
47
Cause of spasticity
a
48
Cause of clonus
a
49
Cause of hyperreflexia
a
50
What are spasticity, clonus and hyperreflexia signs of?
a
51
Decorticate vs decerebrate posturing - presentation and where is the damage?
a
52
What is the clasp knife reflex and what does this indicate damage to?
a
53
Three sites of DBS for treatment of PD
a
54
'Folia'
a
55
Lobes of the cerebellum
a
56
Cerebellum - primary fissure
a
57
Function of cerebellar nodes
a
58
Function of spinocerebellar tract
a
59
On what side of the body will damage to the cerebllum show?
a
60
On what side of the body will damage to the cortex show?
a
61
Cerebellar nuclei
a
62
Function of vestibulocerebellum
a
63
Function of the spinocerebellum
a
64
Function of the cerebrocerebellum
a
65
What is the neocerebellum?
a
66
Input to neocerebellum
a
67
Output from neocerebellum
a
68
Floclonodular lobe syndrome (damage) presentation
a
69
Anterior lobe syndrome (damage) presentation
a
70
Posterior lobe syndrome (damage) presentation
a
71
Common cause of floculonodular lobe syndrome
a
72
Common cause of anterior lobe syndrome
a
73
Common cause of posterior lobe syndrome
a
74
Nystagmus/pstosis/constricted pupil of just one eye is a sign of what type of damage?
a
75
Symptoms of cerebellar stroke
aa
76
Define dysphagia
a
77
Define dysarthria
a
78
Define ataxia
a
79
Dorsal/ventral is anterior/posterior?
a
80
Dorsal/ventral spinocerebellum is ipsilateral or contralateral?
a
81
Two typical histological signs of PD
a
82
What are the three hallmarks of PD (signs)
a
83
What type of symptoms can DBS be used to treat?
a
84
NEED TO GO OVER THE DIRECT AND INDIRECT PATHWAYS ADN HOW THESE CHANGE WITH PD - ARUN/MIMI???
a
85
MPTP
a
86
Impact of MAO on dopamine
a
87
L-dopa to dopamine via which enzyme?
a
88
Amantadine to treat PD
a
89
Mutation in Huntington's disease
a
90
What are the four different stages of pain?
a
91
Two types of nociceptors
a
92
TRPV1 nociceptor responds to?
a
93
TRPM8 nociceptor responds to?
a
94
ASIC3 nociceptor responds to?
a
95
Damage to which nociceptor fibres in diabetic neuropathy?
a
96
Two types of c-fibres
Peptidergic - release of peptides
| Peptide poor - release of ATP
97
C-fibres project to which part of the lamina in the spinal cord and are carried in which tract?
a
98
D-delta fibres project to which part of the lamina in the spinal cord and are carried in which tract?
a
99
What is present in lamina II of the spinal cord?
a
100
What occurs in lamina V of the spinal cord?
a
101
Which part of the brain mediates the unpleasant sensation of pain?
a
102
Role of limbic system in pain?
a
103
Where do projection neurones decussate?
a
104
Function of the amygdala
a
105
Explain peripheral sensitisation
a
106
Four signs of inflammation
a
107
What is central sensitisation?
a
108
Define allodynia
a
109
Define hyperalgesia
a
110
Three signs of central sensitisation
a
111
Define chronic pain
a
112
Define maladaptive pain
a
113
Two types of maladaptive pain
a
114
Define innocuous stimuli
a
115
Define endogenous modification
a
116
Example of endogenous modification
a
117
Gate control theory
The idea that non-painful input closes the gate to painful input
This prevents pain sensation from travelling to the CNS and so suppresses the level of pain that is felt
118
Neurotransmitters involved in central sensitisation
a
119
What are the three cortical components of the limbic system?
Cingulate cortex - anterior and posterior
Orbito-frontal cortex
Parahippocampal cortex/gyrus (medial temporal lobe)
120
Infarct to which arteries can result in damage to the limbic system?
Anterior cerebral artery
| Posterior cerebral artery
121
Define caudal
Of or like a tail
122
Function of rostral anterior cingulate cortex
Registers that pain has occurred
| +potentially what to do in response to this pain
123
Function of caudal anterior cingulate cortex
Registers the quality of the pain i.e. how bad on a scale from 1-10
124
Cingulotomy and function
Cut into the anterior cingulate cortex to prevent the rostro-caudal flow of fibres
Thought to reduce the emotional distress of pain
125
Function of posterior cingulate cortex
Unknown but thought to be involved in visuo-spatial memory
126
Function of parahippocampal cortex/gyrus
Involved in learning and memory
127
Function of orbitofronal cortex
How to behave in response to anticipated threat - how to avoid pain/injury
128
Overactivity of the orbitofrontal cortex is present in which neurological condition?
a
129
Subcortical components of the limbic system
a
130
Function of hippocampus
Time of day that memory occurred and location that the memory occurred AND the commitment of new memories to the long term memory
131
Anterograde amnesia and cause
Failure to transfer new experiences to long term memory
| Damage to the hippocampus
132
Function of the amygdala
Stimulates feelings of fear and anxiety
| Can also stimulate fight or flight response of the sympathetic NS
133
Werknicke-Korsakoffe syndrome and cause
a
134
Temporal lobe epilepsy and cause
a
135
Septum pallucidum
Thin vertical membrane - separates the anterior horns of the left and right lateral ventricles
Runs from corpus callosum to fornix
136
Septum pallucidum
Thin vertical membrane - separates the anterior horns of the left and right lateral ventricles
Runs from corpus callosum to fornix
137
Retrograde amnesia and cause
No access to the memories prior to an event - damage to the cingulate gyrus
138
Lenticulostriate arteries and origin
a
139
Lenticulostriate arteries and origin
Blood supply to basal ganglia and the internal capsule
| Branches from the MCA
140
Vertebral arteries pass through which foramen?
Foramen magnum - then join to form basilar artery
141
Blood supply to the pons
Pontine arteries - branches from the Basilar
142
Blood supply to the brainstem
PICA - from the vertebral artery
143
Structures piercing the dura
Cerebral veins - bridging veins
| Arachnoid granulation - CSF
144
MCA stroke presentation
a
145
ACA stroke presentation
a
146
PCA stroke presentation
a
147
PCA stroke presentation
a
148
ACA stroke presentation
Contralateral sensorimotor loss below the waist
Urinary incontinence
Personality defects
If the corpus callosum is effected - split brain synrome
149
PCA stroke presentation
Damage to the temporal lobe - reading and writing deficits, memory deficits
Contralateral homonymous hemianopia
150
Middle meningeal artery is a branch from which artery?
Third branch of the maxillary artery
151
Middle cerebral artery vs. middle meningeal artery
MCA - continuation of the internal carotid - anterior cerebral blood supply - medially located - within the brain - lentinculostriate arteries branch from here
MMA - blood supply to the meninges - branches from the maxillary artery - laterally located - runs just under the pterion - trauma here leads to extradural haematoma
152
Middle cerebral artery vs. middle meningeal artery
MCA - continuation of the internal carotid - anterior cerebral blood supply - medially located - within the brain - lentinculostriate arteries branch from here
MMA - blood supply to the meninges - branches from the maxillary artery - laterally located - runs just under the pterion - trauma here leads to extradural haematoma
153
Bones forming the pterion
Frontal, sphenoid, parietal, temporal
154
Cerebral falx and function
Septa (dural fold) between the left and right cerebral hemispheres
155
Cerebellum tentorium and function
Septa (dural fold) separating the occipital lobe from the brainstem
156
Tentorial notch and function
Hole in the cerebellum tentorium allowing for the passage of the brainstem and blood vessels to the middle cranial fossa
157
Two layers of the dura mater
Perisoteal layer - closest to the skull
| Meningeal layer - next to the arachnoid layer
158
DO THIS QUIZ FOR DURAL VENOUS SINUSES
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DO THIS QUIZ FOR DURAL VENOUS SINUSES
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159
All layers of meninges from skull to brain
```
Skull
Dura - periosteal layer
Dura - meningeal layer
Arachnoid granulations coming up from the arachnoid mater to drain into venous sinuses
Arachnoid mater
Subarachnoid space
Pia mater
Cerebral cortex of brain
```
160
Imaging bone - x-ray or MRI and why?
X-ray - bone is dense and absorbs high level of x-ray energy
161
Imaging CNS - x-ray or MRI and why?
MRI - mostly water - will not absorb x-rays
162
T1 weighted MRI - colour of bone, air, blood, CSF
Black
163
T1 weighted MRI - colour of fat and bone marrow
White
164
T2 weighted MRI - colour of bone, air, blood, CSF
White
165
T2 weighted MRI - colour of fat and bone marrow
Black
166
Lateral ventricle in relation to the corpus callosum
Immediately inferior
167
Fourth ventricle in relation to the cerebellum
Immediately anterior to the cerebellum and posterior to the brainstem/spinal cord
168
Consequence of enlarged brain ventricles
a
169
Define diffuse head injury
Microscopic damage which cannot be demonstrated by any of the current imaging techniques
BUT unconscious patient
170
Define diffuse head injury
Microscopic damage which cannot be demonstrated by any of the current imaging techniques
BUT unconscious patient
171
Depressed fracture
Area of skull driven inwards
172
Compound fracture
Scalp is torn
173
Closed fracture
The skin is not broken
174
Comminutive fracture
Fragmentation of bone into 2/3 pieces
175
Three theories for the pathophysiology of depression
Monoamine theory - serotonin and noradrenaline dysfunction
Dopamine - reduced levels
Decreased grey matter - at the subgenual cingulate prefrontal cortex
176
Which structure is impaired in depression, causing people to focus more heavily on negative thoughts?
Prefrontal cortex
177
Reversible MAO inhibitors are selective for what?
These are selective for MAOa
178
'Antidepressant drug discontinuation syndrome' + how to avoid this
Immediate cessation of antidepressants in some individuals can result in adverse side effects - should have a slowly reduced degree of the medication over time
179
What is bipolar disorder? + main treatment
Cycles of depression and mania (hyperactivity)
| Lithium
180
How long should patients continue to take antidepressants for following remission?
At least six months to avoid relapse
181
When to use vagal nerve stimulation for the treatment of depression
Chronic depression
182
Advantage of CBT to treat depression
Can augment the pharmacological therapy for depression
183
Target of DBS for depression
Broadmann's area 25/subgenual cingulate cortex
184
Depression can result in reduced white and grey matter in which structure?
Hippocampus
185
When should citrulline be used for treatment of depression?
SRRI - used in patients with heart arrthythmia's/history of MI
186
Mechanism of action of tricyclic antidepressants
These act to reduce the reuptake of monoamines
187
Mechanism of action of SSRIs
Reduce reuptake or serotonin (5-HT) specifically
188
'Cheese effect'
Inhibition of both MAOa and MAOb - should avoid certain foods which cannot be digested - consumption of these foods will result in adverse side effects
189
Which antidepressant drug is safe in overdose?
SSRIs
190
Fluoxetine - what is this and who should it be prescribed to?
SSRI
| Used in patients with depression and diabetes - shown to have positive impact on HbA1c
191
Five key symptoms of depression
```
Anhedonia
Feelings of guilt/lack of self-worth
Weight loss/decrease in appetite
Fatigue
Lack of concentration
```
(suicidal ideation)
192
Give four non-pharmacological treatment options for depression
DBS
Vagal nerve stimulation
Electroconvulsive therapy
CBT
193
Structure of opioid receptors
G-protein coupled receptors
194
Three opioid receptors
Mu
Kappa
Delta
195
Location of opioid receptors
Throughout the body - widespread distribution results in wide range of effects
196
What are enkephalines?
Short morphine-like peptide produced naturally in the body
| Involved in the regulation of nociception
197
Functions of morphine at receptor
Increased potassium conductance and decreased calcium conductance SO reduced excitability of neurone (hyperpolarised) and reduced release of neurotransmitters from neurone
198
Name four common opioid drugs
Morphine
Heroin
Dextromaride
Methadone
199
Opioid naxolone - what should you know?
This opioid/opiate (interchangable) has a very short half life - never leave patient alone with this
200
Three drastic side effects of opiodes
Respiratory depression
Nausea and vomiting
Hypotension
201
Opioid switch
Patients can become tolerant to opioids - should then switch to another type
202
Mechanism of action of paracetamol
Reduces the active oxidised form of COX-2
| Analgesic and antipyretic
203
Mechanism of action of NSAIDs
Reduces COX-1 and COX-2 enzymes
204
Five adverse effects of NSAIDs
```
Arthritis - RA, OA
Gout
Nausea
GI bleeding
Muscle spasms
```
205
Medication types used in the treatment of neuropathic pain
Anticonvulsants
| Tricyclic antidepressants e.g. amitriptyline
206
Name three anticonvulsants and the channels they work on
Sodium valproate - sodium channel
Carbamazepine - sodium channel
Pregabalin - calcium channels
207
Action of tricyclic antidepressants
Inhibit the reuptake of monoamines
| Block both sodium and calcium channels
208
Trigeminal neuralgia
Facial syndrome involving one or more of trigeminal nerve branches
Compression/distortion/stretching
209
Symptoms of trigeminal neuralgia
Sudden, sharp, stabbing pain sensation
210
Treatment of trigeminal neuralgia
Carbamazepine
Baclofen
Phenytoin
Valproate
211
Mechanism of action of local anaesthetic
Block sodium channels
212
Substance P
Peptide released by the peptidergic nociceptive c-fibres
| Released in response to infection/injury and promotes local inflammation
213
Which AEDs increase their own metabolism and how
Phenytoin and carbamazepine
| These increase hepatic enzymes
214
Imperative treatment for status epilepticus
Intravenous benzodiazepine
215
Epilepsy
a
216
Different calcium channels
aa
217
Calcium channels most involved in epilepsy - what type of seizure?
aa
218
Action of pregabalin and gabapentin on epilepsy and mechanism of action
a
219
'Epileptogenesis'
a
220
Stages of a tonic-clonic seizures
a
221
Safest AEDs to administer in pregnancy
a
222
Patient with epilepsy - how many of them will also have a relative with epilepsy?
a
223
Declarative vs. non-declarative memory
| What memory form are these?
Declarative (explicit) - consciously going back in time to recall information
Non-declarative (implicit) - memory acquired and used unconsciously - skills and behaviours e.g. how to perform a dance
Long term memory
224
Two types of declarative memory and what are these?
Episodic - going back in time to remember personal events
| Semantic - remembering general facts about the world
225
'Spatial memory' and region of brain involved in this
Memory related to where you are in space
Based on one's environment and spatial orientation
(Taxi drivers - well developed)
226
Three types of amnesia and what are these?
Anterograde - cannot transform new events into long term memory
Retrograde - cannot remember events occurring prior to the onset of amnesia
Dissociative - cannot remember critical personal information about oneself
227
'Long term potentiation'
The strengthening of synapses due to repetitive behaviours
228
Receptors involved in long term potentiation
NMDA glutamate receptors
229
Define consciousness
Ability to react appropriately to stimuli in the outside world
230
What does an EEG measure?
Voltages across the cerebral cortex
231
EEG appearance when awake and alert
Low amplitude and high frequency
232
EEG appearance when drowsy and close to sleep
High amplitude and low frequency
233
Two functions of sleep
Growth - release of growth hormone
| Wound repair - effect on the immune system
234
Three effects of lack of sleep
Lack of concentration
Hypertension - risk of CVD
Obesity - reduced release of leptin and reduced sensation of satiety
235
How often do the stages of the sleep cycle repeat?
Stages 1-4 repeat every 90 minutes
236
Noradrenaline, serotonin and Ach levels when asleep vs. awake
These are high when awake and low when asleep
237
Function of REM sleep
Consolidation of memories
| Removal of junk
238
Drugs to treat insomnia
Benzodizepines and Z drugs
239
Effect of dopamine on sleep
High levels of dopamine prevents sleep
240
Classical condition vs. operant conditioning
Classical - pairing of two stimuli to illicit a conditioned response
Operant - learning is controlled by consequences (negative and positive reinforcers)
241
Four components of classical conditioning
Unconditioned stimulus - food
Conditioned stimulus - bell
Unconditioned response - salivating in response to food
Conditioned response - salivating in response to bell
242
Define Garcia effect
Avoiding eating certain foods/drink due to a previous unpleasant experience
243
Define theory of tolerance
Ceasing of the conditioned stimulus does not stop the association between conditioned stimulus and response
244
Define social learning
Watching what other people do and how they are rewarded for this and copying their behaviour
245
What are the two most common waves seen in an ECG and when specifically are they seen?
Alpha - seen in most awake adults
| Beta - seen in awake and alert (mental task) adults
246
What causes a change in alpha waves in an awake patient?
Alpha waves are neutral when eyes are closed
Opening of the eyes causes a change in the frequency and the amplitude decreases
Mental activity causes the amplitude of the alpha waves to increase
247
Alpha and beta waves when eyes are open vs. when eyes are shut
Eyes are closed - amplitude of the alpha waves is high and amplitude of beta waves is low
Eyes are open - amplitude of alpha waves is low and amplitude of beta waves is high
248
How is pain tolerance ratio calculated?
Experimental time (may be mean)/control time (may be mean)
